Authors: Monica Manocha, MD, Savannah Pediatrics, & Damien Mitchell, MD, Forest Lane Pediatrics
Pediatricians remain the most important resource for parents who are concerned about their child’s mental and behavioral health. They are also at a unique point to intervene. Mental and behavioral health can both have serious effects on a child, and the rate of pediatric depression is a growing problem in the United States. The Centers for Disease Control and Prevention (CDC) estimates that one in five children has a mental, emotional, or behavioral health disorder, but only 20 percent of those affected receive treatment.
Certain behavioral health disorders, including attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), or otherwise disruptive behavior, can have long-lasting impacts on a child’s development and self-esteem. Exposure to bullying, social media, irregular sleep patterns, and other stressors mean that adolescents have a high incidence of depression. In fact, suicide remains the leading cause of death among adolescents 15 and up.
Because child psychologists, behavioral specialists, psychiatrists, and therapists are spread thin across the United States, mental health diagnoses and check-ups are often the responsibility of the pediatrician. This can create large gaps in care. The American Academy of Pediatrics’ Bright Futures program mandates that pediatricians screen their patients for behavioral and mental health disorders often, but how can pediatricians help close the gap between their practice and their patient’s access to mental health treatment?
Screen and monitor for depression. Although mental health screenings are generally reserved for well-child visits, be sure to monitor behavior and mental health even when patients come in for illness or injury. Screening and monitoring patients for depression can help with early detection and intervention. For children and adolescents who are not comfortable discussing their feelings or symptoms, pre-visit questionnaires can also be an effective means of diagnosing behavioral and mental health disorders. The American Academy of Pediatrics recommends the PHQ-A study which showed“the highest positive predictive value” in several of their studies.
Screen parents for changes in their children’s behavior. Because children and adolescents are not always forthcoming on the pre-visit questionnaire, it is helpful to enlist the parents’ help. The American Academy of Pediatrics has compiled discussion points for pediatricians to have with their patient’s parents.
Pediatricians can maximize the information available to them by asking specific questions about any recent changes in the child’s behavior, school performance, issues at home, and other stressors that may be indicators of mental health problems.
Identify gaps in training. In a study of pediatricians and their attitudes toward mental health care, pediatricians cited a lack of adequate training or resources to help treat pediatric depression as their number one cause for concern in their practices. This is true especially in the case of children from low-income families, when parents may not be able to take the child to appointments. Pediatricians can get extra help through child mental health access programs, which can help them understand how to treat behavioral and mental health disorders in children while taking culture and socioeconomic status into consideration. Additionally, pediatricians may wish to collaborate with mental health providers to get more training in mental health treatment.
Learn more about forming collaborative care networks. To close care gaps, pediatricians can partner with networks that include behavioral and mental health specialists who can intervene on a child’s behalf. Collaborative care models have been proven to reduce emergency room visits in adolescents. Patients do not necessarily have to wait for a referral to see their specialist and pediatricians can ensure patients are referred to the expert most appropriate for their needs. Additionally, team-based care can include family members in the patient’s care, which can increase communication among family members and help reduce mental health care barriers at home.
Procure supplemental handouts. Supplemental education materials can help answer parents’ questions when the pediatrician is unavailable. Pediatric associations have supplemental patient materials available that pediatricians who partner with a managed services organization (MSO) or subscribe to the association’s site can access.
The prior suggestions do not address the significant challenges pediatricians face with respect to liability, lack of access to external resources, and lack of time during visits to adequately assess a patient for behavioral and mental health disorders. While improvement is needed to better close the gap between children and mental health providers, pediatricians can take steps to help optimize their practice in treating the mental health of their patients. Some of these methods, like collaborative care, can improve children’s outcomes while reducing healthcare costs for their families and society.